Centre for Health Services Studies

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Dr Rowena Merritt BSc, D.Phil

Research Fellow

 

 

I am a Research Fellow in CHSS at the University of Kent. I am also an Affiliate Professor at the University of South Florida.

My current projects include:
• Supporting the World Health Organisation to implement the Regional Action Plan for Healthy Newborns in the Western Pacific (2014-2018). This project aims to reduce more than 200,000 unnecessary newborn deaths that occur every year in the Western Pacific region by up to 65%.
• Developing a new social marketing training program for environmental NGO’s in the Kingdom of Jordan, funded by USAID.
• Supporting in the implementation of five social marketing projects within the Kingdom of Jordan. The five projects tackle various environmental issues, from reducing littering to water and energy conservation. All the projects are design to be fully sustainable, post funding, and also aim to build local capacity, efficacy, and skills among the local communities.

My main interest is in social marketing and something termed ‘critical social marketing’ in relation to the formula milk industry. Critical social marketing involves critically investigating the impact of commercial marketing on society from a (social) marketing perspective. This information is then used to inform upstream social marketing activities such as advocacy, lobbying, policy and regulation; as well as downstream social marketing interventions designed to influence consumers or distributors.

Critical social marketing also uses this information to develop an integrated PR and marketing strategy to develop messages, campaigns and engage with the media. My research interests range widely, and I have worked on projects covering the main public health priority areas, including: obesity, breastfeeding, cancer, HIV/STI prevention, mental health, alcohol and drug misuse and smoking. In more recent years, I have focused upon sexual and maternal health, and have been commissioned to work on a growing number of international projects in developing countries (funded by aid agencies, including DFID, WHO and USAID). Most recently I have worked with the Chinese University of Hong Kong to help develop their breastfeeding strategy and also on a number of HIV prevention projects across China and South East Asia.

I joined the University of Kent in 2013. I previously worked as part of the public health team in the Department of Health where I managed the implementation of Ambitions for Health, the Department of Health’s national social marketing strategy.

In 2006 I was awarded my PhD by the University of Oxford. My thesis explored the use of social marketing to improve outcomes for patients with unipolar depression, by improving compliance with both psychological and pharmaceutical treatments. I received a BSc (Honours) in Business Studies from Imperial College for my first degree.

I am the Co-Founder of The Pasifika Collective, a non-profit organisation which helps Pacific Island countries develop sustainable solutions to problems caused by human behaviour such as water pollution, habitat loss and poor community health. We work to build local capacity in the use of evidence-based social marketing approaches to:
• Improve access to water and sanitation
• Reduce water and marine pollution
• Preserve habitat and biodiversity
• Improve the management of natural resources
• Respond to natural disasters and the impacts of climate change
• Strengthen coastal resilience
• Improve health and wellbeing of communities.

 

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Also view these in the Kent Academic Repository

Articles
Merritt, R. K., Hotham, S. and Schrag, A. (2023) 'Support needs in Carers of People with Parkinson's from early to later stages: A qualitative study with 36 carers in 11 European countries', Journal of Geriatric Psychiatry and Neurology.

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Background: Parkinson's Disease (PD) is associated with considerable carer burden, but there has been little qualitative research on the support needs of carers of People with Parkinson's (PwP). Methods: Semi-structured in-depth interviews with carers of PwP in 11 European countries. Results: Interviews with 36 carers of PwP were analysed. At the time of diagnosis, carers often felt that they had a role in helping get a diagnosis and then in dealing with the impact of the diagnosis on the family. Information on medication was seen as particularly important for carers, and many of the carers that their informational needs differed from that of the PwPs. Many of the carers also felt that they needed to be present at all appointments to request referrals or ask for medication changes. Carers of those in the later stages of the disease often reported feeling isolated and not having any time for themselves. Conclusions: The involvement of carers should be addressed more actively in the management of Parkinson's.
Kraemer, K., Beesabathuni, K., Askari, S., Khondker, R., Khan, T. U., Rahman, M., Gibson, S., Merritt, R. K., Bajoria, M., Lingala, S. and others. (2023) 'Knowledge, Attitudes and Practices of Pregnant Women and Healthcare Providers in Bangladesh regarding Multivitamin Supplements during Pregnancy', Healthcare. MDPI. doi: 10.3390/healthcare11050713.

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Micronutrient deficiencies are widespread among pregnant women in low- and middle-income countries (LMIC) and lead to potentially adverse effects for mother and baby. In Bangladesh, maternal malnutrition remains a severe problem, with high rates of anemia (49.6% of pregnant women and 47.8% of lactating women are anemic) and other nutritional deficiencies. A Knowledge, Attitudes, and Practices (KAP) study was conducted to assess Bangladeshi pregnant women's perceptions and related behaviors, as well as awareness and knowledge among pharmacists and healthcare professionals concerning prenatal multivitamin supplements. This was done in both rural and urban areas across Bangladesh. A total of 732 quantitative interviews were conducted (330 with providers and 402 with pregnant women, with an equal split between urban and rural areas for both sets of audiences; 200 women were users of prenatal multivitamin supplements, while 202 women were aware non-users). The study identified a few findings that can guide further research or market-based interventions to reduce micronutrient deficiencies. These include most pregnant women not knowing the right time to start multivitamin supplements (56.0%, [n = 225], stating that a woman should start taking supplements 'after the first trimester'), not knowing their benefits, and how they help both the mother and baby–only 29.5% [n = 59] stated that they believed the supplements helped their baby to grow well). Further, barriers to taking the supplements include women believing a nutritious diet is a substitute (88.7% [n = 293]), and a perceived lack of support from other family members (21.8%, [n = 72]). This suggests that there is a need for further awareness-raising among all pregnant women, their family members, and providers.
Merritt, R. K., Eida, T. J., Safon, C. and Kendall, S. (2023) 'Print media coverage of breastfeeding in Great Britain: positive or negative?', Maternal and Child Nutrition. Wiley. doi: 10.1111/mcn.13458.

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Media can be a powerful communication tool to promote breastfeeding, influence mothers' breastfeeding behaviour, create positive social norms and generate support among stakeholders and policymakers for breastfeeding. However, negative stories could deter women from starting or continuing to breastfeed. This study aimed to describe the breadth and focus of the media coverage of breastfeeding and the message frames that are found in three of the most widely read national newspapers and three popular women's magazines in Great Britain over a 12-month period, as part of the Becoming Breastfeeding Friendly in Great Britain (BBF-GB) study. For this retrospective media analysis, 77 articles were identified and 42 were included in the study for coding and analysis. We conducted two content analyses to examine the articles' (1) message framing and (2) alignment with the eight components of an 'enabling breastfeeding environment' using the BBF Gear framework. Articles featuring breastfeeding appear in British newspapers and women's magazines all year round. Twenty-four per cent had a neutral tone, while 59% predominantly focused on the positive aspects or positive social support for breastfeeding, and 17% were predominantly focused on the negative aspects or negative social attitudes towards breastfeeding. The articles mainly focused on personal stories reflecting societal barriers and positive shifts (68%), with 12% presenting an analysis of breastfeeding evidence or barriers. There were fewer references to the legislation (5%) and availability of funding (2%) and support (9%). There was no coverage of national coordination and strategy, evaluation systems, or the political will to raise breastfeeding rates. KEY MESSAGES: - During the one-year study period, articles featuring breastfeeding appeared in the included British newspapers and women's magazines all year round rather than being focused on specific events, such as World Breastfeeding Week. - Articles mainly focused on personal stories and were initiated by social media posts or discussions on Television by mothers, often celebrity mothers. - While articles discussed the difficulties mothers face during breastfeeding, they also detailed positive support for breastfeeding, presenting a more balanced view. - The articles did not fully reflect BBF's Gear Model components for an enabling breastfeeding environment. Most were categorised as promotion articles with fewer advocacy pieces. There was little coverage of legislation, services and funding while political support, breastfeeding data and strategic oversight were not covered.
Merritt, R. K., Kendall, S., Eida, T. J., Dykes, F. and Perez-Escamilla, R. (2022) 'Scaling up breastfeeding in England through the Becoming Breastfeeding Friendly initiative (BBF)', Maternal and Child Nutrition. Wiley. doi: 10.1111/mcn.13443.

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Breastfeeding is the most accessible and cost-effective activity available to public health and has been shown to be one of the most effective preventive measures mothers can take to protect their children's health. Despite the well-documented benefits, the UK has one of the lowest breastfeeding rates in the world. The Becoming Breastfeeding Friendly (BBF) toolkit was developed through highly structured technical and academic collaboration, led by Yale University. It provides an evidence-based process to help countries assess their breastfeeding status and readiness to scale up, and identifies concrete measures countries can take to sustainably increase breastfeeding rates, based on data-driven recommendations. BBF is grounded in the Breastfeeding Gear Model complex adaptive systems framework which is made up of eight simultaneous conditions that sustain breastfeeding. In 2018, a committee of multi-agency stakeholders implemented the BBF process in England, collecting evidence to score the 'gear' components of England's breastfeeding environment against 54 benchmarks. The Training and Programme Delivery gear received the highest score, attributable to existing learning outcomes for health professionals and practitioners, peer supporters and specialist services, although there is a need for greater coordination and integration. The lowest scores were given for Promotion and Coordination, Goals and Monitoring due to the lack of a dedicated national strategy for breastfeeding and poor sharing of localised strategies and programmes. The process generated clear recommendations highlighting the need for more robust routine infant feeding data collection and reporting, and the necessity for strengthening leadership, monitoring and oversight to scale up and sustain breastfeeding. Key messages: - England's overall weighted Becoming Breastfeeding Friendly (BBF) index score was 1.1 (range 0-3) representing a moderate scaling up environment (range 1.1-2.0). Five gears: Political Will, Legislation and Policies, Funding and Resources; Training and Programme Delivery and Research and Evaluation scored at a moderate gear strength, while the remaining three gears - Advocacy, promotion and Coordination Goals and Monitoring - were weak. - The BBF process for England highlighted substantial gaps in the current breastfeeding practice data and recommended that more robust routine, population-level infant feeding data collection and reporting is initiated that goes beyond 6-8 weeks and up to 2 years. - The process identified that the lack of a national infant feeding co-ordinator role or national breastfeeding committee has resulted in no dedicated workplan and a lack of advocacy for breastfeeding programmes. The need for greater future coordination, strategic goal setting and consistent monitoring was recommended to strengthen the breastfeeding environment.
Dietrich, T., Hurley, E., Carins, J., Kassirer, J., Rundle-Thiele, S., Palmatier, R. W., Merritt, R. K., Weaven, S. K. and Lee, N. (2022) '50 years of social marketing: seeding solutions for the future', European Journal of Marketing. Emerald. doi: 10.1108/EJM-06-2021-0447.

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Purpose This paper looks back to look forward, through a synthesising social marketing literature over the last fifty years, and delivers a set of guiding tenets to propel social marketing's agenda forward. Design/methodology/approach Across three strands, this paper amalgamates theoretical and practitioner evidence from social marketing. This synthesis commences with a review, summary and critical discussion of five decades of social marketing research. Across strand 2 and 3, we review 412 social marketing interventions reported across 10 evidence reviews, and 238 case studies. Findings This paper demonstrates social marketing's use of fundamental marketing principles and capability to achieve behaviour change outcomes. Social marketers have built frameworks and processes that non-profit organisations, government agencies and policy makers seeking to enact change can utilise. This paper delivers 5 tenets that summarise the findings of the three strands and delivers research priorities for the next 50 years of social marketing research to drive the field forward. Research limitations/implications Drawing on five decades of learning, this paper proposes research priorities that can be applied to refine, recalibrate and future-proof social marketing's success in making the world a better place. Practical implications This article demonstrates the value of social marketing science and helps bridge gaps between theory and practice and further strengthen social marketing's value proposition. This paper provides confidence that money invested in social marketing programs is well spent. Originality/value This paper delivers a forward-looking perspective and provides social marketing academics and practitioners with confidence that it can assist in overcoming society's most pressing issues. The paper encompasses key social marketing literature since it was founded 50 years ago. Five tenets will guide social marketing forward: (1) evidencing marketing principles (2) operationalisation of processes, principles and activities (3) implementing systems thinking (4) creating and testing marketing theory, and (5) guiding a new social marketing era.
Merritt, R., Tshering, P. and Suggs, L. (2021) 'To Improve Nutrition and Healthy Eating, We Need to Generate Demand', International Journal of Public Health. doi: 10.3389/ijph.2021.1604390.

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Merritt, R. K., de Groot, J., Almajali, L. and Patel, N. (2021) 'Using Community-Based Prevention Marketing to Generate Demand for Healthy Diets in Jordan', Nutrients. doi: 10.3390/nu13093068.

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Jordan has been experiencing a nutrition transition with high rates of micronutrient deficiencies and rising overweight and obesity rates. This highlights the need to generate demand for healthy diets. This study used a community-based prevention marketing approach and worked with local communities as partners to develop a set of behavior change interventions to improve healthy eating within vulnerable communities. Individual, family, and paired-friendship interviews, and co-creation workshops were conducted with 120 people. The aim of these interviews was to gain an in-depth understand of school-aged children and their families' nutrition knowledge, attitudes, and practices, including social and cultural norms and behavioral determinants, and then use this information to co-create interventions, activities and materials targeted at supporting school-aged child nutrition. Analysis of the interviews revealed that dietary habits are both deeply personal and profoundly entwined by emotions and social norms, and that parents often gave in to their children's demands for unhealthy foods and beverages due to their perception of what a 'good parent' looks like and the desire to see their child 'smile'. These key insights were then shared during the co-creation workshops to develop behavior change interventions—ensuring that interventions were developed by the community, for the community.
Gadsby, E., Hotham, S., Eida, T., Lawrence, C. and Merritt, R. (2020) 'Impact of a community-based pilot intervention to tackle childhood obesity: a "whole-system approach" case study', BMC Public Health. BMC. doi: 10.1186/s12889-020-09694-2.

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Background Go-Golborne was a three-year pilot programme to test an innovative, community-based 'whole system' approach to preventing overweight in children in Golborne ward, London. Whilst there is a growing interest in local whole systems approaches to obesity, understandings of what they look like in practice are newly emerging. Go-Golborne was designed, implemented and evaluated within this context. Methods The evaluation used a case-study design and theory of change approach to assess the effectiveness of the intervention. Height/weight measurements of children in the six participating primary schools were recorded annually for 4 years. For behavioural outcomes, children aged six-11 completed four annual on-line surveys (total 4331 responses). Parents were surveyed in year one and year four (177 responses). Three focus group discussions were held with children aged 10–11 (N = 21); interviews were conducted with parents (N = 11), and school representatives (N = 4). Stakeholders were surveyed twice (37 responses), and interviews were conducted with key stakeholders (N = 11). An extensive range of programme documents were reviewed and additional process data was collected from the programme team. The RE-AIM framework was used to synthesise findings and examine public health impact. Results Go-Golborne reached a diverse range of partners across Golborne. Events were attended by over 3360 local children and families and all six primary schools in the ward actively engaged in activities. The proportion of children in the above healthy weight categories remained stable over time. A number of changes in home, school and neighbourhood environments to support healthy behaviour change were evidenced. There was some qualitative evidence of positive changes in children's behaviours, though significant or sustained changes were not evidenced by the quantitative data. Conclusions Go-Golborne helped stakeholders and parents to develop a shared commitment to improving healthy weight in children, to identify barriers to a healthy lifestyle, and to start to make changes in their services/behaviours. The campaigns and changes made at micro-level appeared to be insufficient, in the face of counteracting forces and personal factors, to achieve significant behaviour change within 3 years. This highlights the need for local initiatives to be reinforced by supporting action at regional, national and global levels.
Merritt, R. K., Vogel, M. and Ladbury, P. (2019) 'A Qualitative Study Exploring Healthy Eating and Physical Activity in Families with Young Children', Interdisciplinary Journal of Health Sciences. American Research Institute for Policy Development, pp. 8-13. doi: 10.18192/riss-ijhs.v9i1.2289.

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Overweight and obesity in childhood affects health long-term. Parent attitudes and behaviours play major roles in their child's weight despite no consensus on appropriate and effective family-focused interventions to successfully tackle childhood obesity. This research aims to explore caregiver perceptions, attitudes, and behaviours around children's diet, exercise, and weight in East Sussex. In-depth qualitative interviews with mothers, fathers, and grandparents of children aged 2-11 years were conducted. Caregivers wanted to influence their children's diet and exercise habits but were unable due to perceived and actual barriers. Barriers included cost, time, and a lack of control over food choices as children aged. Moreover, caregivers admitted to providing unhealthy sweets and snacks to please their children. While caregivers openly discussed their own weight concerns, they were less likely to discuss concerns about their children's or grandchildren's weight. When asked about the ideal amount of exercise, caregivers found it easy to describe a regime for adults but did not know the ideal amount of exercise for children. Many caregivers found it difficult to quantify exercise when it came to their children because children naturally played in ways that could be considered exercise. Family-based interventions should begin in early childhood and promote walking and dog-walking as forms of exercise, parental education on childhood exercise guidelines, and preparing and eating healthy home-cooked meals in the home.
Schrag, A., Zhelev, S., Hotham, S., Merritt, R. K., Khan, K. and Graham, L. (2019) 'Heterogeneity in progression of prodromal features in Parkinson's disease', Parkinsonism & Related Disorders. Elsevier, pp. 275-279. doi: 10.1016/j.parkreldis.2019.05.013.

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Background: In the pre-diagnostic phase of Parkinson's disease (PD), a range of motor and non-motor symptoms can occur. However, there is considerable variability in their onset and currently little information exists on the pattern of progression of clinical features before diagnosis. Methods: We analysed data from a survey amongst patients with PD from 11 European countries by the European Parkinson's Disease Association. They completed questions on first occurrence of 21 pre-diagnostic features. A principal component analysis (PCA) with varimax rotation was performed to determine the co-occurrence of these features. Findings: 1,467 patients were included. Changes in movement were the most commonly reported features up to 4 years before diagnosis. However, at five or more years before diagnosis loss of sense of smell, sleep problems, fatigue and other non-motor features had been experienced most frequently. PCA of pre-diagnostic features' duration revealed three factors with eigenvalues over Kaiser's criterion of 1: a) a neuropsychiatric factor comprised of anxiety, depression, apathy, stress, and sleep problems; b) an axial factor defined by difficulty eating and/or swallowing problems, freezing, and falls/balance problems; and c) a motor factor with additional non-motor features. Bladder/bowel problems and tremor had low factor loadings on all components. However, in those with disease duration less than 5 years the autonomic features were associated with the axial factor and tremor loaded on both the motor and psychiatric symptom factors. Interpretation: The identified symptom complexes in the pre-diagnostic stage of PD may be reflective of a shared pattern of pathological disease progression.
Merritt, R. K., Vogel, M., Ladbury, P. and Johnson, S. M. (2019) 'A qualitative study to explore fathers' attitudes towards breastfeeding in South West England', Primary Health Care Research & Development. Cambridge University Press. doi: 10.1017/S1463423618000877.

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Aim: To explore the beliefs, attitudes, and behaviours of fathers towards breastfeeding and how they impact either positively or negatively on their partners' decisions to initiate or continue breastfeeding. Background: Despite policy initiatives at a national and international level and the increased number of baby-friendly hospitals within the UK, breastfeeding rates are slow to rise. Support from both parents has been proven to increase uptake and continuation rates, but there is little research into the emotional experience of fathers when it comes to breastfeeding. Methods: We conducted qualitative interviews with 18 fathers in Wiltshire, England. Principles of grounded theory were used throughout this study to guide the sampling, data collection, and data analysis. Findings: Fathers knew the health benefits of breastfeeding and wanted their child to breastfeed but were unsure of their place in the feeding process because they felt it was not their body. While they were aware of the benefits of breast milk for infants, fathers felt less informed of the practicalities of breastfeeding and the potential challenges they and their partner might have to overcome to breastfeed successfully for the recommended six-month period. Based on these findings, three segments were identified: the problem bonders, the dual bonders, and the pragmatists. All segments were concerned with the well-being of their partner and child and wanted their child to be breastfed. Health professionals can use the results of this study to create prenatal educational resources that take more of a preventive and problem-solving approach as opposed to promoting breastfeeding in efforts to comply with National Health Service guidelines, without offering solutions to common breastfeeding problems.
Merritt, R. K., Hotham, S., Graham, L. and Schrag, A. (2018) 'The subjective experience of Parkinson's disease: a qualitative study in 60 people with mild to moderate Parkinson's in 11 European countries', European Journal of Person Centered Healthcare. European Journal of Person Centered Healthcare. doi: 10.5750/ejpch.v6i3.1536.

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Objective: To describe the experience of being diagnosed and living with mild to moderate Parkinson's disease (PD). Method: Semi-structured in-depth interviews with people with Parkinson's (PwP) in 11 European countries. Results: Interviews with 60 PwP (52% male) with a mean age of 63 (SD 8.1) years and a disease duration of 9.6 (SD 6.9) years were analysed. PwP often delayed help-seeking due to lack of awareness of symptoms, and there was sometimes a delay in specialist referral. The diagnosis typically came as a "shock", making PwP unable to absorb all the information, but having a diagnosis for the symptoms was sometimes described as a "relief". Prompt referral to a specialist, a clear and sensitively communicated diagnosis with reassurance about life expectancy, and a follow-up appointment with a PD nurse or other health care professionals a short interval after diagnosis were all positively viewed. Many reported worries and negative experiences with medications and wished for more time and information before initiating these. Reactions from family, friends, and work colleagues when communicating the diagnosis were typically positive. During ongoing care, longer appointments with specialists and provision of information from health care professionals, patient organisations, and self-help groups were considered important to many PwPs and helped them feel as if they could "take control" and manage their disease more effectively. Conclusions: Taking into account these findings has the potential to improve the experiences of PwP through improved communication, tailoring of appointments and information provision including self-help approaches. ? Introduction The impact of Parkinson's disease (PD) on patients health-related quality of life has been studied extensively, demonstrating that all aspects of physical and emotional functioning can be affected in PD even at the earliest stages of the disease (Schrag et al., 2000). Management of PD aims at improving quality of life in people with Parkinson's (PwP) using pharmacological, surgical and non-pharmacological strategies (Ferreira, et al. 2013). In order to improve quality of life in PwP, research has primarily focussed on quantitative assessments of motor and non-motor symptoms to optimise their medical treatment and thereby PwP' wellbeing (Nicoletti et al., 2017). However, relatively little is known on the experience of being diagnosed with and living with PD from the point of view of PwP. This is particularly relevant when advising health care providers and clinicians on the non-medical aspects of managing PwP in current health care systems. We here report the results of a qualitative study in 60 individuals with a diagnosis of PD from 11 European countries on their experiences of being diagnosed and living with this disorder. Methods In 2014 and 2015, a qualitative research study was conducted as part of the "My PD Journey" project by the European Parkinson's Disease Association (EPDA). Semi-structured interviews on the experiences of being diagnosed and living with PD were conducted with people with Parkinson's (PwP) in 11 countries. Principles of Grounded Theory were used to guide the sampling, data collection, and data analysis (Glaser & Strauss, 2009).
Schrag, A., Khan, K., Hotham, S., Merritt, R., Rascol, O. and Graham, L. (2018) 'Experience of care for Parkinson's disease in European countries: A survey by the European Parkinson's Disease Association', European Journal of Neurology. Wiley, pp. 1410-e120. doi: 10.1111/ene.13738.

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Background: Few studies report on experience of care for Parkinson's disease (PD) from patients' own point of view. Methods: Analysis of a survey in 11 European countries on self-reported access to services and satisfaction with different aspects of care. Results: 1,775 people with PD (PwP) participated with disease duration ranging from <1 to 42 years. Initial referral to specialists had taken <3 months in most but medication reviews occurred every 3 months in only 10%, every 6 months in 37%, once a year in 40%, and every two years or less frequently in 13%. Waiting times to therapists were usually at ?4 months. Satisfaction with care was highest for involvement of PwP in decisions (63% of respondents satisfied) and involvement of family/carer (62%) followed by communication with PwP (57%), information received (54%), frequency of treatment reviews (52%), suitability of treatment for the individual condition and circumstances (52%), but lowest for availability and accessibility of treatment when needed (48%) and collaborations between healthcare professionals in delivering care (41% satisfied). The main factors associated with overall satisfaction scores with care were the overall satisfaction with initial consultation (r=0.26, p<0.0001), the sensitivity with which the diagnosis was communicated, the quantity of information provided (both r=0.24, p<0.0001) and the frequency of medication review (r=0.17, p<0.0001). Conclusion: More coordinated and responsive care, tailored to the individual, with regular and timely medication reviews and treatment referrals, is likely to improve satisfaction with care in current health care pathways.
Schrag, A., Modi, S., Hotham, S., Merritt, R., Khan, K. and Graham, L. (2018) 'Patient experiences of receiving a diagnosis of Parkinsons's disease', Journal of Neurology. Springer, pp. 1151-1157. doi: 10.1007/s00415-018-8817-8.

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Objective: To report patients' own experiences of receiving a diagnosis of Parkinson's disease (PD) and to identify factors influencing this experience. Methods: A survey by the European Parkinson's Disease Association in 11 European countries. Results: 1775 patients with an average age of 69.7 years participated of whom 54% were male. Those living in rural areas reported having waited longer to seek medical help (p < 0.05). A possible diagnosis of PD was made at the first appointment in a third of respondents. When the diagnosis was made, only 50% reported that the diagnosis was communicated sensitively. 38% of patients reported having been given enough time to ask questions and discuss concerns, but 29% did not. 98% of participants reported having been given information about PD at the time of diagnosis but 36% did not find the information given helpful. Patient satisfaction with the diagnostic consultation was positively associated with more sensitive delivery of diagnosis, the helpfulness and quantity of the information provided and time to ask questions (all p < 0.001). Where diagnosis was given by a specialist, participants reported greater perceived satisfaction with the diagnostic consultation, greater sensitivity of communicating the diagnosis, time to ask questions, provision and helpfulness of information, and earlier medication prescription (all p < 0.0001). Conclusions: There is a need to improve how the diagnosis of PD is communicated to patients, the opportunity to ask questions soon after diagnosis, and the amount, timing and quality of life information provided, as this is associated with greater satisfaction with the diagnostic process.
Hashem, F. and Merritt, R. K. (2018) 'Supporting patients self-managing respiratory health: a qualitative study on the impact of the Breathe Easy voluntary group network', European Respiratory Journal. European Respiratory Society, pp. 1-11. doi: 10.1183/23120541.00076-2017.

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Self-management strategies are designed to improve lung and respiratory health through structured self-management plans with regular practitioner reviews. Strategies have not however focused upon how patient support groups and advocacy networks can help with the management of these conditions, therefore it is unknown what impact they may have on patient self-management. A qualitative study was designed to help understand what impact the British Lung Foundation's (BLF) Breathe Easy (BE) groups have with patients managing their lung and respiratory conditions. A semi-structured telephone interview schedule was developed to study the network. Topics covered included: perceptions about the BE groups; current referrals systems and integration pathways; benefits of attending the BE groups; and integration of the BE groups into the respiratory pathway. Key themes explored included: shared patient experience and peer-support; patient self-management and self-education, attendance of healthcare professionals, and the impact of integrating BE groups into the respiratory pathway. BE networks were shown to support self-care initiatives for people attending the groups and members expressed a social and educational benefit. BE networks were working with the local NHS to become an integral part of the respiratory pathway, yet, there was evidence of resistance from the health service in incorporating the networks.
Merritt, R., Kamin, T., Hussenöder, F. and Huibregtsen, J. (2017) 'The History of Social Marketing in Europe: The Story So Far', Social Marketing Quarterly. SAGE, pp. 291-301. doi: 10.1177/1524500417732771.

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This article presents the ways in which social marketing has been used in Europe, the contribution it has made to tackling major health issues, and the challenges it has faced. The extent to which social marketing is used varies greatly across Europe, although the past decade has seen a rise in EU-wide funded Social Marketing Programs. Despite the inconsistent and rather sporadic use of social marketing in Europe, some of the European aid organizations continue to fund numerous social marketing programs in developing countries. The European social marketing community need to continue to work together to promote its value and gain continued political buy-in for the discipline.
Book sections
Merritt, R. K., Hafeez-ur-Rehman, H. and Patel, N. (2022) 'Marketing and the UN SGDs', in Kubacki, K., Parker, L., Domegan, C., and Brennan, L. (eds) The Routledge Companion to Marketing and Society. Routledge. doi: 10.4324/9781003028079.

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Merritt, R. K. (2021) 'National Social Marketing Centre, UK', in Fourali, C. and French, J. (eds) The Palgrave Encyclopedia of Social Marketing. Palgrave Macmillan. doi: 10.1007/978-3-030-14449-4_32-1.

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Merritt, R. K. (2018) 'Breastfeeding and breast milk - From biochemistry to impact', in Breastfeeding and breast milk - From biochemistry to impact. Georg Thieme Varlag KG.

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Monographs
Kendall, S., Eida, T. J. and Merritt, R. K. (2019) Becoming Breastfeeding Friendly Scotland: report. Scottish Government. Available at: https://www.gov.scot/publications/becoming-breastfeeding-friendly-scotland-report/pages/3/.

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Background: Breastfeeding and the provision of human milk is the most accessible and cost-effective activity available to public health, which is known to prevent a range of infectious and non-communicable diseases (NCDs), specifically gastro-enteritis, childhood obesity, diabetes type 2 and maternal breast cancer[1],[2]. However, global efforts to further improve exclusive breastfeeding rates have had limited success, in part because effective scaling‐up frameworks and roadmaps have not been developed[3]. Breastfeeding rates in Scotland have improved in recent years, with an increase from 44% (2001/2002) to 51% (2017/2018) of babies reportedly receiving 'any breastfeeding' at first health visitor visit at 10-14 days, and the proportion of babies being breastfed at 6-8 weeks rising from 36% of babies (born in 2001/02) to 42% of babies (born in 2017/18)[4] However, the figures remain relatively low and drop off rates high when compared to other countries and recommended targets, with breastfeeding rates lower among women in areas of higher deprivation, exacerbating health inequalities. BBF: The Becoming Breastfeeding Friendly (BBF) toolkit was developed through highly structured technical and academic collaboration, led by Yale University and has been piloted in Mexico and Ghana. In the short term, it provides an evidence-based tool to guide countries in assessing their breastfeeding status and their readiness to scale up. In the long term, it supports countries to identify the concrete measures they can take to sustainably increase breastfeeding rates, based on data-driven recommendations. The BBF Gear Model is made up of eight simultaneous conditions which sustain breastfeeding: the gears. This conceptual model illustrates how each gear must be sufficiently mobilised to turn the next, whilst the central Coordination gear gathers and delivers timely feedback. Using the BBF framework, the BBF Scotland committee has prioritised a set of eight recommendation themes to take forward in order to scale up the protection, promotion and support of breastfeeding in Scotland.
Eida, T. J., Kendall, S. and Merritt, R. K. (2019) Becoming Breastfeeding Friendly Wales infographic. Public Health Wales.

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In Wales, whilst over 60% of women intend to breastfeed, the figure falls to 26% reporting any breastfeeding at 6 weeks. There is considerable variation among Health Boards and breastfeeding rates are lower among some groups, exacerbating health inequalities. Sustained intervention is required to both improve the experience of breastfeeding for women, babies and families, and advance towards the WHO's 2025 global target of increasing exclusive breastfeeding in the first six months to at least 50%. Supported by the University of Kent and facilitated by Public Health Wales, a Welsh Committee of experts worked from April 2018 to February 2019 to deliver the 5 step BBF process: a) to measure the current breastfeeding environment, and b) to develop a plan to implement recommendations to guide the scaling up of national breastfeeding protection, promotion and support efforts. This infographic presents the findings of the assessment of the Breastfeeding environment in Wales and the committee's six evidence-informed recommendation themes, based on the BBF Gear model.
Kendall, S., Eida, T. J. and Merritt, R. K. (2019) Becoming Breastfeeding Friendly (BBF) Wales Recommendations Briefing Report. Public Health Wales.

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Background: Breastfeeding and the provision of human milk is the most accessible and cost-effective activity available to public health which is known to prevent a range of infectious and non-communicable diseases (NCDs), specifically gastro-enteritis, childhood obesity, diabetes type 2 and maternal breast cancer. However, global efforts to further improve exclusive breastfeeding rates have had limited success, in part because effective scaling‐up frameworks and roadmaps have not been developed. The UK has one of the lowest breastfeeding rates in the world; 80% of babies are breastfed at birth and only 1% are exclusively breastfed by 6 months. In Wales, whilst over 60% of women intend to breastfeed, the figure falls to 26% reporting any breastfeeding at 6 weeks, with considerable variation among Health Boards and breastfeeding rates lower among women in areas of higher deprivation, exacerbating health inequalities. Sustained intervention is required to improve the experience of breastfeeding for women, babies and families and work towards the WHO's 2025 global target of increasing exclusive breastfeeding in the first six months to at least 50%. BBF: The Becoming Breastfeeding Friendly (BBF) toolkit was developed through highly structured technical and academic collaboration, led by Yale University and has been piloted in Mexico and Ghana. In the short term, it provides an evidence-based tool to guide countries in assessing their breastfeeding status, and their readiness to scale up. In the long term, it supports countries to identify the concrete measures they can take to sustainably increase breastfeeding rates, based on data-driven recommendations. The BBF Gear Model is made up of eight simultaneous conditions which sustain breastfeeding: the gears. This conceptual model illustrates how each gear must be sufficiently mobilised to turn the next, whilst the central Coordination gear gathers and delivers timely feedback. This report contains a set of briefings detailing the six themes and their accompanying recommendations and actions.
Conference or workshop items
Merritt, R. K. (2021) 'Can we make social marketing more nimble?', in. Social Marketing: A Behavioural Change Rebel Turning 50.

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Eida, T. J., Kendall, S. and Merritt, R. K. (2018) 'Becoming Breastfeeding Friendly in Britain Scaling up Breastfeeding in Wales, Scotland and England', in. Institute of Health Visiting conference.

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The UK has one of the lowest breastfeeding rates in the world; 80% of babies are breastfed at birth, only 1% are exclusively breastfed by 6 months. Breastfeeding rates are lower among women in areas of higher deprivation, exacerbating health inequalities. The Becoming Breastfeeding Friendly toolkit was developed through highly structured technical and academic collaboration, led by Yale University. It has been piloted in Mexico and Ghana. In the short term, it provides an evidence-based tool to guide countries in assessing their breastfeeding status, and their readiness to scale up; and in the long term, it supports countries to identify the concrete measures they can take to sustainably increase breastfeeding rates, based on data-driven recommendations. Launching BBF GB, breastfeeding experts from Scotland, Wales and England attended the first GB Engagement Committee in December 2017, agreeing to deliver BBF separately in each country to reflect structural and cultural variation. The CHSS team is now supporting three locally developed Country Committees of experts in Scotland, Wales and England to carry out the 5 step meeting process.
Eida, T. J., Gadsby, E. W., Hotham, S. and Merritt, R. K. (2017) 'Go Golborne Action Learning Event: Partner survey and interviews', in. Action Learning Event.

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The causes of obesity are complex; tackling the problem requires evidence-led action at every level, from the individual to society, and across all sectors. As part of their whole system strategy to halt and reverse the rising trend in childhood obesity, the London Bi-borough Public Health team are delivering Go Golborne, an innovative 3 year community-based pilot (2015-2018), in a highly diverse and deprived ward in the Royal Borough of Kensington and Chelsea (RBKC), with elevated levels of childhood obesity. CHSS is conducting a 4 year theory-led evaluation of the pilot to assess the effectiveness, feasibility and replicability of this 'whole place' multi-stakeholder approach. This presentation details the early findings of an online survey distributed to project partners and interview findings with project partners.
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Social marketing, evidence-based social marketing approaches, critical social marketing, public health, qualitative research

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My motivation for mentoring

I have been a Research Fellow in CHSS since 2013. I work part-time at CHSS and run my own consultancy business with the rest of my time.  I specialise in social marketing and behaviour change. In 2006, I completed my D.Phil in social marketing from the University of Oxford. After graduation, I went to work at the Department of Health England and was part of the small team that set-up the National Social Marketing Centre.
Whilst working at the Department of Health, I started to do more international projects (funded by DFID) and in 2010 I set up my own consultancy. Now I mainly do work for UN organisations, including WHO and WFP, specialising in achieving behaviour change to improve maternal and new-born outcomes and sexual health. Over the past ten years I have worked in over 15 countries, delivering behavioural change programmes at local and national levels. As part of this work, I do a lot of capacity building and mentoring of local UN staff.
I am also an Affiliate Professor at the University of South Florida and Chair their social marketing conference and teach their online advanced social marketing course.
I understand what it is like to try and juggle a career with bringing up a family, and the pressures of trying to deliver projects on the ground in very difficult environments.

Apply for mentorship

If you would like me to be your mentor, please fill in the mentor application form here.

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Last Updated: 28/09/2020